Zitelli J A, Mohs F E, Larson P, Snow S
Department of Medicine, Montefiore Hospital, University Health Center of Pittsburgh, Pennsylvania.
Dermatol Clin. 1989 Oct;7(4):833-43.
The results of multiple investigators have confirmed the value of Mohs surgery in the treatment of melanoma. In addition, these studies have contributed to our understanding of the biologic behavior of melanoma. The success of Mohs surgery confirms that melanoma grows in a contiguous fashion before it spreads systemically. It is known that once tumor breaks away from the main mass, trying to improve survival by increasing the extent of conventional surgery is often fruitless. Therefore, the goal of surgery is to remove all of the tumor, including the silent contiguous foci. If melanoma did not grow in a contiguous fashion before metastasis, the results of Mohs surgery would be inferior to wide excision, and higher local recurrences would be expected. Instead, the excellent results support the concept of contiguous tumor growth. Satellites and in-transit metastases that appear later may be removed with the fixed-tissue technique. We have also learned that melanoma sends out silent contiguous extensions, necessitating excision of some normal-appearing skin. The width of those extensions is unrelated to the depth of the melanoma. The value of Mohs surgery is the ability to identify these extensions microscopically and to excise tumor-bearing tissue while sparing normal skin. In fact, Mohs surgery often spares a diameter of 1.8 cm or more when compared with standard surgery, a distinct advantage to patients whose melanomas are on the head, neck, hands, feet, or genitalia or in patients whose melanoma has indistinct clinical margins and would require an even wider margin of normal skin when using standard surgical techniques. We now have long-term results from large numbers of patients--confirmed by multiple investigators and data--to support the concept of Mohs surgery for melanoma. This information emphasizes the important role that Mohs micrographic surgery plays in the treatment of melanoma.
多位研究者的结果证实了莫氏手术在黑色素瘤治疗中的价值。此外，这些研究有助于我们了解黑色素瘤的生物学行为。莫氏手术的成功证实，黑色素瘤在发生全身转移之前是以连续方式生长的。众所周知，一旦肿瘤从主体肿块脱离，试图通过扩大传统手术范围来提高生存率往往是徒劳的。因此，手术的目标是切除所有肿瘤，包括隐匿的连续病灶。如果黑色素瘤在转移前不是以连续方式生长，莫氏手术的结果将不如广泛切除，并且预期局部复发率会更高。相反，出色的结果支持了肿瘤连续生长的概念。稍后出现的卫星灶和途中转移灶可用固定组织技术切除。我们还了解到，黑色素瘤会发出隐匿的连续延伸，因此需要切除一些外观正常的皮肤。这些延伸的宽度与黑色素瘤的深度无关。莫氏手术的价值在于能够在显微镜下识别这些延伸，并切除含肿瘤组织，同时保留正常皮肤。事实上，与标准手术相比，莫氏手术通常能保留直径1.8厘米或更大的皮肤，这对黑色素瘤位于头、颈、手、脚或生殖器部位的患者，或者黑色素瘤临床边界不清晰、使用标准手术技术需要更宽正常皮肤切缘的患者来说，是一个明显的优势。我们现在有大量患者的长期结果——经多位研究者和数据证实——来支持莫氏手术治疗黑色素瘤的概念。这些信息强调了莫氏显微手术在黑色素瘤治疗中所起的重要作用。
